Investigating the timing and site of recurrence for ovarian clear cell carcinoma: Analysis of the JGOG/GCIG trial-JGOG 3017-A3

BACKGROUND

This study was conducted to determine the optimal monitoring after initial treatment of ovarian clear cell carcinoma (OCCC) using data from patients enrolled in the Japanese Gynecologic Oncology Group (JGOG) 3017 study. The JGOG study evaluated the efficacy of an irinotecan and cisplatin combination regimen compared with that of a paclitaxel and carboplatin regimen for OCCC patients who underwent primary surgery.

METHODS

Yielding 619 total patients in this study, to analyze progression-free and overall survival, the hazards over time were estimated using kernel smoothing curves to identify the peak of event occurrence. The number of progression events was summed by progression site, and the cumulative incidence proportion was estimated for the major progression sites, considering competing risks.

RESULTS

The peak hazard for progression or death was observed at 12 months post-treatment, and most events were observed by 24 months. The hazard for death peaked at 18 months post-treatment, with most events being observed by 48 months. The hazard for lung, liver, and spleen metastases remained constant for 18 months post-treatment, with a decreasing trend thereafter; most events were observed by 18 months. The hazard for peritoneal dissemination was constant for 12 months, with a decreasing trend thereafter, with most exacerbations observed by 24 months. The risk of pelvic recurrence peaked at 6 months, with most exacerbations observed by 24 months.

DISCUSSION

The incidence of progression events for OCCC peaked at 12 months and most progression events occurred within 24 months. Close follow-up for the initial 24 months post-treatment and fewer visits thereafter may be acceptable. However, closely monitoring symptoms and examining patients based on differences in progression rates at different sites may be important.

Vincazalidine A, a unique bisindole alkaloid from Catharanthus roseus

A new dimeric indole alkaloid, vincazalidine A consisting of an aspidosperma type and a modified iboga type with 1-azatricyclo ring system consisting of one azepane and two piperidine rings coupled with an oxazolidine ring was isolated from Catharanthus roseus, and the structure including absolute stereochemistry was elucidated on the basis of spectroscopic data as well as DP4 statistical analysis. Vincazalidine A induced G2 arrest and subsequent apoptosis in human lung carcinoma cell line, A549 cells.

Formulation of energy loss in a four-way circular manhole at crossroad

Energy loss at a manhole which is at a junction of storm sewers or combined sewers is important for accurately estimating its discharge capacity. However, even in Japan, the energy loss at the manhole is usually ignored in designing sewers and flood inundation analysis. One of the reasons for the ignorance is difficulty to formulate the energy loss at the manhole because the number of variables which must be considered increases as the number of sewers connected to the manhole increases. The authors have formulated the energy loss of a four-way circular manhole with three inflow sewers and one outflow sewer at crossroad. The formula is applicable only to the equal flow rates in two opposite lateral inflow sewers. In this paper, a new formula for the energy losses is proposed based on experimental data on a four-way circular manhole with different flow rates on three inflow sewers. It shows that the energy losses calculated with it almost reproduce the measured ones.

O-187 Smartphone application improves fertility treatment-related literacy: A large-scale surveillance and randomized controlled trial in Japan

Study question

Can providing quality-assured fertility-related information via a smartphone application improve fertility- and treatment-related literacy among smartphone application users?

Summary answer

Provision of quality-assured fertility-related information via a smartphone application contributed to enhancing fertility- and treatment-related literacy among the smartphone application users.

What is known already

For infertility patients, the interpretation of examination results may be overly complicated and complex, and patients may have difficulty in making sense of their own fertility problems. Accessing and learning about fertility-related information using the Internet via smartphone is reasonable; however, the information does not always reflect evidence-based recommendations and low-quality information may lead to adverse effects on users; thus, innovative methods to provide both accessible and high-quality information are desired.

Study design, size, duration

We performed a randomized control-group pretest posttest study and 4,137 smartphone application users were invited to participate between June 18 and 25, 2020. Participants’ fertility treatment-related literacy were assessed with a pretest that comprised of 28 questions and participants were allocated with stratified randomization to either intervention or control group. The intervention comprised a one-week smartphone application-based provision of information on fertility- and treatment-related information and the control group received general information about women’s healthcare.

Participants/materials, setting, methods

The 3,765 participants (91.0 %) who responded were randomly allocated into either the intervention group (N = 1883) or the control group (N = 1882). Characteristics of participants appeared similar between the groups reflecting that the randomization was successful in producing a balance in baseline characteristics. Effectiveness of intervention was assessed using pretest-posttest analysis. Ethical approval was obtained from the Institutional Review Board of the National Center for Child Health and Development of Japan (approval number: 2019-184).

Main results and the role of chance

The posttest was completed by 659 participants (17.5%), and finally 207 participants in the intervention group and 222 participants in the control group were available for pretest-posttest analysis. Demographic characteristics of these participants appeared similar between the groups. In comparing the demographic characteristics of participants who did and did not complete the posttest, there were significant differences between the two groups in age, overall test score, proportion living with a partner, and action for pregnancy. For the posttest, the overall mean test scores were significantly higher in the intervention group compared to the control group (P = 0.0082). Interestingly, we also observed that posttest scores were significantly improved compared to pretest scores in both the intervention group and control group (P < 0.001). When examining by specific test question, the proportion answering correctly appeared to generally increase at posttest compared to pretest for intervention (P < 0.001) and control (P < 0.001) groups. There was over 10% improvement in 7 questions, and particularly, over 20% improvement for a question about clinical significance of anti-Müllerian hormone. Furthermore, directly comparing the difference in posttest versus pretest scores between the two groups showed, on average, greater improvements in the intervention group than the control group (P < 0.001).

Limitations, reasons for caution

As the intervention was educational material, it was not possible to blind participants to intervention group assignment. We were not able to monitor the participants when completing the tests; thus, whether they accessed other resources could not be addressed.

Wider implications of the findings

Providing information through a smartphone application can be considered acceptable since retrieving information through a smartphone application is in line with the current modern day lifestyle. A smartphone application may offer alternatives such as chatbots and movie-based learning, and they have the potential to increase the effectiveness.

Trial registration number

UMIN Clinical Trials Registry number UMIN000040721.

Harmonising clinical trials within the Gynecologic Cancer InterGroup: consensus and unmet needs from the Fifth Ovarian Cancer Consensus Conference

The Gynecologic Cancer InterGroup (GCIG) Fifth Ovarian Cancer Consensus Conference (OCCC) was held in Tokyo, Japan from 7 to 9 November 2015. It provided international consensus on 15 important questions in 4 topic areas, which were generated in accordance with the mission statement to establish 'International Consensus for Designing Better Clinical Trials'. The methodology for obtaining consensus was previously established and followed during the Fifth OCCC. All 29 clinical trial groups of GCIG participated in program development and deliberations. Draft consensus statements were discussed in topic groups as well as in a plenary forum. The final statements were then presented to all 29 member groups for voting and documentation of the level of consensus. Full consensus was obtained for 11 of the 15 statements with 28/29 groups agreeing to 3 statements, and 27/29 groups agreeing to 1 statement. The high acceptance rate of the statements among trial groups reflects the fact that we share common questions, and recognise important unmet needs that will guide future research in ovarian cancer.

Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup: recurrent disease

This manuscript reports the consensus statements regarding recurrent ovarian cancer (ROC), reached at the fifth Ovarian Cancer Consensus Conference (OCCC), which was held in Tokyo, Japan, in November 2015. Three important questions were identified: (i) What are the subgroups for clinical trials in ROC? The historical definition of using platinum-free interval (PFI) to categorise patients as having platinum-sensitive/resistant disease was replaced by therapy-free interval (TFI). TFI can be broken down into TFIp (PFI), TFInp (non-PFI) and TFIb (biological agent-free interval). Additional criteria to consider include histology, BRCA mutation status, number/type of previous therapies, outcome of prior surgery and patient reported symptoms. (ii) What are the control arms for clinical trials in ROC? When platinum is considered the best option, the control arm should be a platinum-based therapy with or without an anti-angiogenic agent or a poly (ADP-ribose) polymerase (PARP) inhibitor. If platinum is not considered the best option, the control arm could include a non-platinum drug, either as single agent or in combination. (iii) What are the endpoints for clinical trials in ROC? Overall survival (OS) is the preferred endpoint for patient cohorts with an expected median OS < or = 12 months. Progression-free survival (PFS) is an alternative, and it is the preferred endpoint when the expected median OS is > 12 months. However, PFS alone should not be the only endpoint and must be supported by additional endpoints including pre-defined patient reported outcomes (PROs), time to second subsequent therapy (TSST), or time until definitive deterioration of quality of life (TUDD).

Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup (GCIG): clinical trial design for rare ovarian tumours

This manuscript reports the consensus statements on designing clinical trials in rare ovarian tumours reached at the fifth Ovarian Cancer Consensus Conference (OCCC) held in Tokyo, November 2015. Three important questions were identified concerning rare ovarian tumours (rare epithelial ovarian cancers (eOC), sex-cord stromal tumours (SCST) and germ cell tumours (GCT)): (i) What are the research and trial issues that are unique to rare ovarian tumours? There is a lack of randomised phase III data defining standards of care which makes it difficult to define control arms, but identifies unmet needs that merit investigation. Internationally agreed upon diagnostic criteria, expert pathological review and translational research are crucial. (ii) What should be investigated in rare eOC, GCT and SCST? Trials dedicated to each rare ovarian tumour should be encouraged. Nonetheless, where the question is relevant, rare eOC can be included in eOC trials but with rigorous stratification. Although there is emerging evidence suggesting that rare eOC have different molecular profiles, trials are needed to define new type-specific standards for each rare eOC (clear cell, low grade serous and mucinous). For GCTs, a priority is reducing toxicities from treatment while maintaining cure rates. Both a robust prognostic scoring system and more effective treatments for de novo poor prognosis and relapsed GCTs are needed. For SCSTs, validated prognostic markers as well as alternatives to the current standard of bleomycin/etoposide/cisplatin (BEP) should be identified. (iii) Are randomised trials feasible? Randomised controlled trials (RCT) should be feasible in any of the rare tumours through international collaboration. Ongoing trials have already demonstrated the feasibility of RCT in rare eOC and SCST. Mucinous OC may be considered for inclusion, stratified, into RCTs of non-gynaecological mucinous tumours, while RCTs in high risk or relapsed GCT may be carried out as a subset of male and/or paediatric germ cell studies.

Hydroxyapatite: catalyst for a one-pot pentose formation

Hydroxyapatite powder catalyzes the production of ribose from C1 and C2 carbon sources in one pot in hot water.

Force-induced IL-8 from Periodontal Ligament Cells Requires IL-1β

During orthodontic tooth movement, mechanical stresses induce inflammatory reactions in the periodontal ligament (PDL). We hypothesized that chemokines released from PDL cells under mechanical stress regulate osteoclastogenesis, and investigated the profiles and mechanisms of chemokine expression by human PDL cells in response to mechanical stress. In vitro, shear stress and pressure force rapidly increased the gene and protein expressions of IL-8/CXCL8 by PDL cells. Consistently, amounts of IL-8 in the gingival crevicular fluid of healthy individuals increased within 2 to 4 days of orthodontic force application. The PDL cells constitutively expressed low levels of IL-1β, which were not further increased by mechanical stress. Interestingly, neutralization of IL-1β abolished IL-8 induction by mechanical stresses, indicating that IL-1β is essential for IL-8 induction, presumably though autocrine or paracrine mechanisms. Finally, experiments with signal-specific inhibitors indicated that MAP kinase activation is essential for IL-8 induction.